Laserfiche WebLink
Date run 2/25/2015 10:44:02AI SAN JO COUNTY ENVIRONMENTAL HEALWEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 2/25/2015 <br /> Record Selection Criteria: Facility ID FA0009788 <br /> Make changes/corrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION Number of facilities for this owner: 86 SSN/Fed Tax ID <br /> Owner ID OW0001176 New Owner ID <br /> Owner Name CITY OF STOCKTON <br /> Owner DBA <br /> Owner Address 425 N EL DORADO ST <br /> STOCKTON, CA 95202 <br /> Home Phone 209-937-8212 <br /> Work/Business Phone 209-937-8341 <br /> Mailing Address 425 N EL DORADO ST <br /> STOCKTON, CA 95202 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility lD/CERS ID FA0009788 10182905 <br /> Facility Name CITY OF STOCKTON FIRE STATION#5 <br /> Location 3499 MANTHEY RD <br /> STOCKTON, CA 95206 <br /> Phone 209-937-8801 x <br /> Mailing Address 3499 MANTHEY RD <br /> STOCKTON, CA 95206 <br /> Care of STOCKTON FIRE STATION#5 <br /> Location Code Alt Phone <br /> BOB District Fax <br /> APN 16422004 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0016788 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name CIT OFS I EDEPARTMENT (Circle One) <br /> Account Balance as of 2/25/20 305.00 <br /> (Circle One) <br /> Tarsier lc ActiveAnaclve <br /> PrograrNElement and Description Record ID Employee ID and Name Stat Naw Owh , Delete <br /> 1921 -HMBP-Regular-Primary Location PR0539640 EE0009817-ROBERT LOPEZ Ive,l Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PR0512076 EE0000000-HAZ MAT SJC OES nactivc Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE F PR0509788 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2840-AST EXEMPT FAC <1,320 GAL PRO628826 EE0000005-FATINAH ZAREEF Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,and'or project specific,PHSEHD hourly charges associated with this facility <br /> or activity will be billed to the party identifietl as the OWNER on this form I also canny that all operations will be performed in accordance with all applicable Ordinance Codes anNor Standards and State ardor <br /> Federal Laws. <br /> APPLICANT'S SIGNATURE: Date <br /> Program Records to be TRANSFERED: '$25.00= Amount Paid Date <br /> Water System to be TRANSFERED: Amount Paid Date <br /> Payment Type Check Number ^^ Receive b <br /> / 2 � <br /> REHS: Date 2— 5/�ccAccount out: Date 2,i7W //.5 <br /> COMMENTS: <br />